Module 7 - Hand Injuries

Ligament Injuries

Each of the interphalangeal and metacarpal phalangeal joints in the hand have radial and ulnar collateral ligaments. These can be injured as part of open lacerations or may occur as isolated closed injuries after an avulsion or twisting type of injury. The most common of these injuries is Gamekeeper's or Skier's thumb. This is caused by an injury to the ulnar collateral ligament of the metacarpal phalangeal joint of the thumb. After the ulnar collateral ligamnet is avulsed from its distal insertion on the base if the proximal phalanx, it folds back under the adductor pollicis muscle. The fibrous band prevents the healing of the ulnar collateral ligamnet resulting in a permanent instability of the metacarpal phalangeal joint of the thumb. This leads to pain, deformity, weakness. The optimal treatment for a complete rupture or avulsion of the ulnar collateral ligament of the thumb is surgical reattachment of the ligament to the proximal phalanx of the thumb and immobilization for four weeks. The treatment for partial injury is immobilization for four weeks in a plaster cast.

Other injuries of the ligaments of the hand are not as common but may be equally problematic. PIP joint dislocations are associated with injuries to the collateral ligaments and volar plate of the joint. These can be treated with buddy taping and early mobilization to re-establish normal range of motion prior to scarring. Gross instability should be addressed surgically by repair of the ligaments and immobilization. Other ligament injuries of the hand may be associated with open lacerations and should be addressed surgically.

Author: Dr. SF Morris